Provider First Line Business Practice Location Address:
PO BOX 642
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSBURN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83849-0642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-773-8111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2025